Disorders such as the periodic paralyses, nondystrophic myotonias, episodic ataxias, paroxysmal dyskinesias, long QT syndrome, migraine headache, and epilepsy all share the feature of being episodic in nature. Affected individuals are often completely healthy between attacks. Stress and fatigue precipitate attacks in all of these diseases, and various dietary factors can also contribute to attack onset. The drugs used to treat these disorders overlap significantly.
Carbonic anhydrase inhibitors are effective for many patients with periodic paralysis, episodic ataxia, and migraine headache. Mexiletine hydrochloride, an effective antiarrhythmic medication, can be beneficial in treating myotonia in patients with paramyotonia congenita. The anticonvulsant carbamazepine is an extremely efficacious drug for treating the episodic movements of paroxysmal kinesigenic dyskinesia. All of these disorders have a tendency to begin in infancy or childhood and to worsen through adolescence and young adult life. In some cases, they decrease in severity and frequency in middle to late adult life.
Epilepsy and stroke are the 2 most common epilepsy and neurological disorders: at any one time 7 in 1000 people in the general population have epilepsy. Epilepsy usually begins in childhood, potentially impeding education, employment, social relationships and development of a sense of self-worth. Prompt, accurate diagnosis with appropriate social and medical management will optimize the situation. A family physician, in conjunction with a neurologist, can ascertain (a) if the episodes represent epileptic seizures and (b) if so, which epileptic syndrome they represent.
A harmonized partnership between family physician and neurologist will facilitate the recognition and care of epileptic disorders. As the role of the family physician in the care of patients with epilepsy increases, the principles delineated in this article will be ever more utilized. Trigeminal neuralgia is defined as sudden, usually unilateral, severe, brief, stabbing recurrent episodes of pain within the distribution of one or more branches of the trigeminal nerve, which has a profound effect on quality of life. The diagnosis is made on history alone, and time needs to be taken to elicit the key features and differentiate from toothache or one of the trigeminal autonomic cephalalgias. Most trigeminal neuralgia is idiopathic, but a small percentage is due to secondary causes for example, tumours or multiple sclerosis which can be picked up on CT or MRI.
Recently published international guidelines suggest that carbamazepine and oxcarbazepine are the first-line drugs. There is limited evidence for the use of lamotrigine and baclofen. If there is a decrease in efficacy or tolerability of medication, surgery needs to be considered.
Managing acute pathology of often relies on the addressing underlying pathology and symptoms of the disease. There is currently a need in the art for new compositions to treatment of Epilepsy and neurological disorders.